Methods We retrospectively included 162 eyes of 162 treatment-naïve patients with PCV in this study. All patients were treated with an initial series of three monthly loading doses of anti-VEGF injections, followed by further injections as required. Baseline ocular characteristics and lesion features were assessed using fluorescein angiography, indocyanine green angiography and spectral domain optical coherence tomography, to determine and evaluate the potential risk factors for RPE atrophy through 2 years of follow-up.

Results RPE atrophy had developed in 17 of 162 eyes (10.5%) after 2 years of anti-VEGF treatment. Nine cases (53.0%) of RPE atrophy occurred at branching vascular networks, and eight (47.0%) developed at locations with polyp or polyp-associated pigment epithelial detachment. Among the baseline characteristics, the mean subfoveal choroidal thickness was significantly thinner (192±98 vs 288±152; p=0.009) and presence of subretinal drusenoid deposits was significantly more frequent in eyes with RPE atrophy (11.8% vs 2.1%; p=0.028). Using multiple logistic regression analysis, the mean subfoveal choroidal thickness (OR 0.975; 95% CI 0.929 to 1.324; p=0.002) was identified as a significant risk factor for the development of RPE atrophy.

Conclusions Approximately one-tenth of the patients with PCV developed RPE atrophy during the 24 months after intravitreal anti-VEGF injections. Subfoveal choroidal thinning at baseline is associated with increased risk of post-treatment RPE atrophy.

Data availability statement The data that support the findings of this study are available from the corresponding author, HJC, upon reasonable request.

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